Treatments for Attention Deficit and Hyperactivity Disorder (ADHD) in Children

Boston Children's Hospital's clinicians are regarded as world leaders in diagnosing and treating attention-deficit/hyperactivity disorder (ADHD). Your child is always treated as an individual, and never “just a patient.”

Our compassionate, family-centered care model considers you and your family central members of the treatment team, and you are involved in your child's care from beginning to end.

What are the first steps in treating ADHD at Boston Children's Hospital?

When you come to Boston Children's for an initial appointment, your child's treating clinician will:

give your child a thorough physical exam

go over your child's medical, family and school history with you

talk to you (and your child) about his behaviors, symptoms, feelings and concerns

in some cases, give your child a comprehensive neuropsychological assessment—a sophisticated evaluation of his thinking, learning and behavioral functions

Because Boston Children's is a multidisciplinary center with experts in all relevant fields, your child's treatment plan will involve much more than medical care to manage his ADHD symptoms. You (and he) will also have access to an assortment of educational, emotional and psychosocial support services to meet all of your family's needs.

What treatment options does Boston Children's normally prescribe for kids with ADHD?

There are three major components of treatment for kids with ADHD here at Boston Children's:

medication

behavioral modification therapy

educational intervention

For some children, it may be appropriate to start with behavioral modification therapy and move to medication only if behavioral treatments don't work well enough. (As an example, if you have attended a behavioral parent training class, the teacher has worked for several months on classroom interventions and your child has received focused treatment—but you still see considerable room for improvement in his behavior and rate of progress—you and your child's treating clinician might consider starting him on medication.)

For many kids with ADHD, the combination of medication and behavioral approaches should be considered from the very start.

Medication

Stimulant medications (drugs that enhance the activities of the brain and nervous system) have been used to treat ADHD and related childhood disorders since the 1930s. These medications have proven to be very effective in improving the basic symptoms of ADHD—including inattention, impulsivity and hyperactivity—in up to 90 percent of children.

Stimulant medications work well for ADHD because they are able to “balance out” the brain chemicals that make it hard for kids with the disorder to maintain attention and control their impulses.

These medications are available in different preparations under various brand names. The drugs will differ in how they're administered (for example, in tablets or capsules) and in how long they are effective (short-acting or long-acting).

Considerations before beginning medication

There are a few considerations involved when stimulant medications are prescribed for ADHD:

duration — Your doctor will likely want to prescribe the longest-acting preparation to control your child's symptoms throughout the day, both in and out of school.

side effects — Different kids respond to these medications in different ways. If your child has negative side effects when taking a certain medication, the doctor may recommend trying a different one.

tics (sudden, repetitive movements or sounds that are difficult to control)

re-emergence of symptoms when the medication wears off in the evening (unfortunately, this is usually the very time you want your child to be “winding down” for the day)

Most side effects associated with stimulant medications:

are mild

decrease with regular use

respond well to changes in the particular drug, dose and preparation

Before starting your child on a stimulant, your treating clinician will obtain a thorough medical and family history and perform a physical examination, including checking your child's pulse, blood pressure and heart rate. Electrocardiograms (EKGs) and further heart tests are not usually necessary, unless an abnormality shows up in your child's medical or family history or during a physical exam.

An important note: If your child has any type of heart problem, she should always be examined and cleared by a cardiologist before beginning any new medication.

A combination of behavioral modification therapy and medication is usually more effective than either approach alone, at least in the short term. Your child's treating clinician is the best source of information in determining what treatment methods to try, when to implement them and for how long.

Educational intervention

A structured educational setting can be an especially difficult place for a child with ADHD. That's why the federal government has put some special rules in place to help kids with ADHD and other learning and behavioral conditions succeed in school.

In order to qualify for special educational services through an IEP, your child must have demonstrated proof of either significant behavior problems in school that require special services or an associated, diagnosed condition, such as another learning disability.

Eligibility for Section 504 is based on the confirmed existence of an identified physical or mental impairment that substantially limits a major life activity. In other words, a diagnosis of ADHD is not enough; your child's ADHD must also significantly—and demonstrably—affect his learning and/or behavior.

If your child is deemed eligible under Section 504 and attends a public school, you can request that his teachers provide accommodations for his inattention and/or hyperactive and impulsive symptoms, such as:

giving him frequent reminders to stay on task

reducing distractions

rewarding persistence

prompting him to double-check work, complete assignment books and turn in homework

giving him extra time to complete work

providing opportunities for physical activity or "boredom breaks" during the day

providing a variety of interesting approaches to learning

giving rewards for good control of behavioral impulses

giving consequences for failing to control behavioral impulses

Support and education for parents

Raising and caring for a child with ADHD can be very stressful at times, and may often present challenges for the entire family. In these circumstances, parent support and education about ADHD can make a big difference.

Boston Children's Hospital offers classes in behavior management skills for parents. Training in these skills usually occurs in a group setting, which encourages parent-to-parent sharing and the brainstorming of ideas. Contact our Department of Psychiatry to learn more.

Coping and support

The ups and downs experienced by a child—and family—living with attention-deficit/hyperactivity disorder (ADHD) can feel overwhelming sometimes. In addition to the information provided here, you may find comfort and support from the following resources:

Patient and family resources at Boston Children's

Boston Children's Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the center's services at no extra cost. The Center for Families is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.

The ADHD Experience Journal was designed by Boston Children's psychiatrist-in-chief David DeMaso, MD, and members of his team. This online collection features thoughts, reflections and advice from kids and caregivers dealing with ADHD.

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the fourth year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.